Do we use conscious sedation too readily as the answer for our anxious patients?
NewsPosted by: Dental Design 26th April 2019
Student dentist Charlotte Gentry looks at the advantages and disadvantages of conscious sedation on anxious patients.
Conscious sedation is widely used to treat patients who are unable to receive dental treatment for many different reasons.
It is relatively simple to carry out, has few contraindications and has a wide margin of safety – that is for both inhalation and intravenous sedation. However, there is still the question – is sedation always really beneficial for the patient? Ultimately, their anxiety isn’t cured, particularly with intravenous sedation, and therefore should we be using it less readily in order to help combat dental anxiety?
I have just completed my week on sedation as part of my undergraduate training. Not only did I experience sedating patients, I also saw new patients who have been referred into the hospital. Although many of the patients did have extreme dental anxiety and would have benefitted from conscious sedation, it became apparent to me that many just needed a little TLC. By providing these patients with reassurance and more time, their anxieties were able to be managed with non-pharmacological methods.
An example of this was a patient I saw at outreach clinics last year. She was extremely needle phobic, was tearful and shaken up talking about treatment, and at first was adamant she did not want any treatment unless it was under sedation. With some reassurance, topical anaesthetic and time to listen to her concerns, I managed to do a few restorations and a crown prep under local anaesthetic. Although this was a success, I am aware that for some patients, non pharmacological methods just would not work no matter how hard we try. However, I really believe that more time and effort needs to be put into trialling these methods with patients, before jumping straight into a referral letter.
Despite this, I am not naïve and I realise that in most NHS dental practices, there is barely enough time to do everything required as it is. Therefore, finding time to try non-pharmacological techniques on these patients is near enough impossible. Nevertheless, sometimes it only takes small things, such as starting with simpler parts of the treatment plan and building them up to the more complex things, enabling the patient to have their treatment in their local practice, perhaps. This builds rapport and trust and makes a huge difference. Not only this, but their anxiety will have been ‘cured’ as they have had a positive experience that they can remember.
I am not saying sedation doesn’t have a place- it most definitely does. Not just for extremely anxious patients, but for some medical conditions and gagging patients too. It means those that are usually most in need of treatment, having neglected their dentition because of their anxieties, are able to have the procedures carried out. I just feel that with limited resources and long waiting lists, perhaps we need to try to help these patients a little more in our own dental chairs first, before referring them for conscious sedation.
